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APPLICATII..� FOR COWSTRUC'i .JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />320o CEdAR STRFET • EVERETT, WA 98201 • 259-8810 <br />� 1 DEMOLITION f! COMBINATION i I BUILDING " MECHANICAL i; PLUMBING f i SIGN <br />ADDRESS <br />� <br />owr:en <br />, �� vJ L, <br />PPCHITf.CT OH UESIGNEfI <br />Mm�nDoncss - <br />LF_ `?$!U <br />�.�a�nnoness <br />MNII. ADDPE55 <br />n -m r�roue <br />�'.�rzr_Tr 9�.��3 �b8-a�c�y <br />rv nv rv�or�e <br />GfNCRAICONiP�CTOR 4•AIIADDqE55 Qi\� 71P PIIONE SIATELICGNSE� <br />kE'H�NICA:CONiP�CTOR A1AILqDDAE55 CIiY 21P PNONE STATFUCENSE� <br />PIUMBINGCONiRaCTOfi MAIL�DDNESS CIN 21P PNONE SiATEUCENSE� <br />DESCPIBE WOpN ANO SOUAIiE POOTFGE INVOLVFO <br />rnoreseo use ov euiioiwc <br />iecn� oescr�mrior� or raoai <br />LOT BLOCK <br />ra�mxr <br />CONSiRUPTI0Nl0ANLENDER,AD�RE55.TELCPHONE NUMAEP <br />NO. 1 VPE OF FIXTU <br />WATER CLOSET (TOILE <br />BATH7UB <br />LAVATORY QNASH BASI <br />�HOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAV <br />C! OTHES WASHER <br />OR <br />DRINKIhIi FOUNTAIN <br />FLOUR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ETC.) <br />SU� TOTAL 5 <br />PERMIT S <br />TOTALFEE 5 <br />FOR OFFICE USE ONLY: <br />FRONT rFT[i/CN REA115F.TBACK SAE SE!B�CK <br />USE 20N[ <br />I IEIGH f LIM!TATION <br />Tra� or <br />LOTAREA <br />NO OFOWELLING <br />uNirs <br />DATE <br />VACANt SIIE <br />I 1 YI:S <br />51zE or OtOGRI <br />FEE <br />fl NO <br />H�ATING SYSTEM: I 1 GAS f� ELECTRIC I l <br />C,ONiACT Pf RSON A6'D PIION[ N0. <br />I HEREBY CERTIFY THAT I HAVE READ AND EY,AMINEU THIS <br />APPUCATION AND KNOW THE SAME TO 8[ TRUE AND COiiRF.CT. ALL <br />PRO'JISIONS OF LAWS AND ORDINAIJCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHEIHER SPECIFIeD HEREIN OR <br />NOT. THE GRANTING OF A PERMIT UOES NOT °9ESUMe TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF P.NY <br />OTIiER STATE OR LOCAL LAW REGULATING CONSTRUOTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY i0 PERFORM THE VJORK FO�i WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AtJD 296200 WAC. <br />x � S-/�'9� <br />EIGN4iURE OAIE <br />QTV 11USINF55 LICL'JSE NO <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />AIC —MiNDLG UNITS — H.P. � <br />FORCED AIR SYSTEMS — 9.T.U. M E.A. ; <br />HEAT PUMP � <br />� <br />UNIT HEATERS — 6.T.11. �1 <br />CLOTHES DRVERS i <br />VENTILATION FAtJ <br />RANGEHOOD i <br />WATER HEATEH <br />WOOD STOVE ' <br />METAL FIREPLACE (WO00 BURNING) i <br />[H_F9:1dVLe]� <br />SUB TOTAL S <br />PEFMIT 5 <br />TOTALFEE $ <br />rtnucrrecK nunm�i� � r�E � aeccirT No. <br />ouaoi+�c <br />FEES I VALUATION I FEE <br />rwunir�c <br />45EMENi M[CIIRNICAL <br />❑YES f7 NO — <br />AOOITIONAI. PIAV CHECK <br />on�En <br />srni� auaowc suRCNnnce <br />CITY OP EVERET'f ruoiich�anKs <br />LOCALSALES <br />TAX CODE IS 3105 TO7Al <br />